This instructional course lecture reviews when to use reverse shoulder arthroplasty for irreparable massive rotator cuff tears in patients who do NOT have glenohumeral arthritis. It covers the pathomechanics of cuff deficiency, the indications and contraindications, expected outcomes, and how to avoid operating on conditions that mimic pseudoparalysis.
When you see a massive irreparable cuff tear WITHOUT arthritis, the decision to do a reverse hinges on one physical exam finding: active forward elevation. If the patient cannot get above 90° (pseudoparalysis), the fulcrum is gone and the reverse reliably restores elevation, with outcomes equal to cuff tear arthropathy cases.
If the patient still elevates past 90°, force couples are intact. Operating here risks LOSING motion and produces far higher dissatisfaction (27% vs 7%), so favor injections, biceps tenotomy, or partial repair instead.
Before committing, prove the deltoid works. A nonfunctional deltoid from cervical radiculopathy, prior open cuff surgery, or axillary nerve injury is an absolute contraindication. Radicular pain radiates past the elbow; cuff pain does not. Counsel revision patients that prior surgery raises infection and reoperation risk compared with a primary reverse.
This instructional course lecture reviews when to use reverse shoulder arthroplasty for irreparable massive rotator cuff tears in patients who do NOT have glenohumeral arthritis. It covers the pathomechanics of cuff deficiency, the indications and contraindications, expected outcomes, and how to avoid operating on conditions that mimic pseudoparalysis.
When you see a massive irreparable cuff tear WITHOUT arthritis, the decision to do a reverse hinges on one physical exam finding: active forward elevation. If the patient cannot get above 90° (pseudoparalysis), the fulcrum is gone and the reverse reliably restores elevation, with outcomes equal to cuff tear arthropathy cases.
If the patient still elevates past 90°, force couples are intact. Operating here risks LOSING motion and produces far higher dissatisfaction (27% vs 7%), so favor injections, biceps tenotomy, or partial repair instead.
Before committing, prove the deltoid works. A nonfunctional deltoid from cervical radiculopathy, prior open cuff surgery, or axillary nerve injury is an absolute contraindication. Radicular pain radiates past the elbow; cuff pain does not. Counsel revision patients that prior surgery raises infection and reoperation risk compared with a primary reverse.